title: Current spectrum of malabsorption syndrome in adults in India.
abstract: OBJECTIVE
  Tropical sprue was considered to be the most important cause of malabsorption in adults in India. However, several reports indicate that celiac disease is now recognized more frequently.
  
  
  METHODS
  We analyzed the clinical presentation, endoscopic and histological features of 94 consecutive patients (age >12 years) with chronic diarrhea and malabsorption syndrome. The spectrum of disease in these patients and features differentiating celiac disease and tropical sprue are reported here.
  
  
  RESULTS
  Celiac disease (n = 61, 65%) was the most common cause of malabsorption followed by tropical sprue (21, 22%). Other conditions including cyclosporiasis (3), Crohn's disease (2), common variable immunodeficiency (2), lymphangiectasia (1), William's syndrome (1), and idiopathic malabsorption (3) accounted for the remainder. A greater number (21, 34%) of patients with celiac disease than those with tropical sprue (4, 19%) presented with atypical manifestations. Patients with celiac disease were younger (p = 0.001), more often had anemia, (p = 0.001), scalloping of folds (p = 0.001), moderate (p = 0.02) or severe (p = 0.001) villous atrophy, higher grade of intraepithelial lymphocytic infiltration (p = 0.001), crypt hyperplasia (p = 0.001), cuboidal (p = 0.001) and pseudostratified (p = 0.009) surface epithelial cells, and diffuse (p = 0.001) epithelial damage. In comparison, patients with tropical sprue were older and more often had normal duodenal folds, normal villi, tall columnar epithelial cells and focal epithelial damage.
  
  
  CONCLUSIONS
  Celiac disease was the most frequent cause of malabsorption syndrome in this series of patients. There are significant clinical and histological differences between celiac disease and tropical sprue.
authors.affiliation: Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Yadav
authors.forename: Prasenjit
authors.initials: P
authors.lastname: Das
authors.forename: Bijay R
authors.initials: BR
authors.lastname: Mirdha
authors.forename: Siddhartha Datta
authors.initials: SD
authors.lastname: Gupta
authors.forename: Shinjini
authors.initials: S
authors.lastname: Bhatnagar
authors.forename: Ravinder M
authors.initials: RM
authors.lastname: Pandey
authors.forename: Govind K
authors.initials: GK
authors.lastname: Makharia
mesh_terms: D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007194:India; D008286:Malabsorption Syndromes / Q000175:diagnosis* / Q000469:parasitology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D013182:Sprue, Tropical / Q000175:diagnosis*; D055815:Young Adult